Saturday, October 20, 2012

Circles and Cycles

This is undoubtedly the strangest thing that has ever
happened to me…

One of my little schemes for paying the mortgage is to train
people to speak in public. A surprising number of people need this skill, and a
lot of them don’t realize until they make fools of themselves. Candidates for
the oral part of civil service exams, young employees wanting to impress the
boss, salesmen who need to stand out at a conference, people running for public
office, they all want help, and some of them call me.

It’s mostly academics and professionals, and it’s mostly in
English, although it doesn’t have to be. The techniques are different when you
are not using your mother tongue, but the basic problems and skills to be
practised are the same.

One man who trains with me is a doctor, who is sometimes
required to address congresses and other demanding audiences in English. He is
a good communicator in many ways, but his English is not quite up to some of
the tasks he undertakes, and so together
we seal a few of the cracks and give him a little extra confidence.

This doctor, who we shall call Santos, for no particular
reason, doesn’t live in the small city which I adopted some years ago and which
has, in turn, adopted me. He works at a small hospital in a town some 20 miles
away, and lives about another 20 miles beyond that. Nevertheless, he thinks it
worth his while to drive here twice a week after work to learn and practise
with me.

Not long ago he was asked to give a talk, in English, on
some aspect of emergency procedure. A gathering of medical and administrative
personnel from around Europe had been invited so they could show off our new
teaching hospital, and they wanted something didactic, dramatic, bloody, and
theoretically useful. It had to be worthwhile for the doctors to sit and listen
to it, but it also had to convince them that the non-medical people present
would learn from it. It had, in short, to be professional, clinical, smooth, it
had to look and sound good. His sponsors were looking for a performance, of
which the practical benefit was only a part.

He had decided the topic by the time he spoke to me about
it. He wanted to explain how to do an emergency tracheotomy, which is nicely
dramatic and bloody. I questioned him in detail about the likely audience,
which should be the starting point for any speaker, but is often forgotten. We
discussed the language and terminology he would need, ways of structuring the
text, styles of presentation, and how to fit it all to the time. And he went
away to produce a draft.

The next day we looked at it, I corrected it, we discussed
the pronunciation of certain difficult but essential terms, and removed some
difficult, non-essential words. You don’t want to spend half the time worrying
about whether your attempt at some key word is going to be taken off the bat.
We trimmed it a bit, I reduced it to a larger number of smaller conceptual
units- the difference would be more in his mind than in the text itself, but it
makes a difference- and he went away again to make a final version.

When it was ready and he was happy with it, we did a dress
rehearsal, in which I was the audience. Reading from a sheet gives great
confidence to the speaker, but it can very easily distance the speaker from the
audience. To read as though speaking ex tempore in one of the skills they come
to me to learn.

His performance was superb. He is, I am certain, a fine
doctor. He brings competence, responsibility and hard work to everything he
does. He had practised diction, delivery, interaction, he was aware at all
times of the speed and intonation of his voice and he never forgot that he was
there to tell people things that they wanted to hear. Even without the slides-
he had prepared a bit of visual support, but we decided for the run-through it
wasn’t worth setting anything up; pressing a button every so often wasn’t going
to affect him in any important way- it was gripping. I pronounced him ready to
face his public.

We cut to the following Saturday morning. I was walking in
the country, as I do. Just outside the city, as I passed an isolated and
apparently abandoned house, I heard a form of screech. My expert ear
immediately identified it as a young female Homo sapiens expressing strong
emotion. But this was not the strong emotion produced by seeing a friend
approaching, or hearing about what A said B did with C in the broom cupboard,
or noticing a lovely pair of boots in a shop window. It was a different kind of
screech, and it that made my blood run cold. Something was very wrong, and
there was no one else about.

I ran around the corner of the building. There were two
girls, in fact, both about 12, one bent over, screaming, the other on the
ground, twitching horribly. The screaming girl grabbed my arm and managed to
say ‘she can’t breathe… she can’t breathe…’ I had expected to find a wild
animal, a big dog or a wounded boar, perhaps, or a man attacking her. I would
have known what to do. I might have done it badly, but I would have had a plan.
This was beyond me.

I dropped down beside her. No, she couldn’t breathe. She
wasn’t wheezing, asthmatic, drunk, drugged or anything like that. No air could
enter her lungs. None. Why not, I asked the friend. She had been licking a kind
of gobstopper when she laughed and sucked it in, and she fell down. I had to do
something very, very fast. But what?

I had dialled the emergency number almost as I heard the
first scream, and I gave the phone and the GPS I carry to the friend, and told
her what to tell them. The girl’s eyes were turning red, and the rest of her
blue. The words Heimlich manoeuvre swam before my eyes. I could feel the ball
in her throat, it felt big and hard and a long way down. I sat her up as best I
could, squatted behind her and tried to squeeze her firmly just below the
diaphragm. Even if I’d known where the diaphragm actually was, the sweet wasn’t
going to move. It was too firmly lodged.

The word tracheotomy swam before my eyes. I knew how to do
one, at least in theory. But does she need one? She needed something. The ball
wasn’t coming out and she couldn’t breathe. Oddly enough, it was the face of
the friend that cooled my brain to the point where it could do something like
thinking. I saw in her face what I should have seen in the choking girl’s: in
30 seconds she would be dead, and I had to save her, because I was there. The
logic of children can be compelling. Her friend could not die, because that
sort of thing doesn’t happen, and as I was the only adult there I would be the
one who would save her. I could see it in her face and so it had to be true. I
took the phone and heard a distant, commanding voice which sounded a little
like mine that I was about to perform a tracheotomy and the ambulance crew
should be ready to treat the consequences. And I went to work.

The principle of the tracheotomy is very simple. If the
windpipe is blocked and air can’t enter, and you can’t unblock it, then you
make a hole belong the obstruction, keep it open with a tube, and the patient
breathes once more. In the rucksack I always carry when out walking or riding I
carry a large number of things, on the grounds that you never know. I took out
the first aid kit, a small hunting-knife, a lighter, and a ballpoint pen.

I thought back to the lecture I had heard. Dr Santos was a
very good performer indeed. When we had done the rehearsal I was more
interested in the sound of it, the interaction of the speaker with the
audience, the use of the voice and the eyes, the length of sentences, the authority
of the speaker, with the performance as a whole, rather than with the content,
but it had got over. It was there in my head. Despite the lack of slides, I
could picture every detail of the operation as it should be performed. I could
see the folds of muscle I had to use to navigate, the cartilage I must avoid,
the point I had to find where the bleeding would be minimal and the
introduction of the tube easiest. There was also some stuff about severing the
flesh in several stages to avoid the larger veins and the isthmal gland, but
dismissed it as fussy and irrelevant. I put the blade of the knife in the flame
of the lighter and prepared to act.

All of this took much less time than it takes to tell.
Disturbing as it is to watch a young girl die before your eyes as you prepare
to slice open her windpipe- and believe me it is absolutely bloody terrifying-
everything changes when you have a plan, a purpose. You become calmer, at least
calm enough to act. You think of nothing else. Time moves slowly but smoothly.
Your responsibility is no longer to save a life that is draining away as you
watch- a daunting job to thrust upon anyone- but to plunge a knife through
flesh. That, you think, I can do. Easy, no problem. This is done and dusted.

The details are blurred, for which I’m grateful. But it was
messy. If you’ve ever cut uncooked meat with a knife, or prepared a rabbit for
cooking, you’ll know how hard it is. The flesh slides away from you and refuses
to be controlled. When you have 10 seconds to make the cut this can be quite
nerve-wracking. But the knife went in. It reached the place it had to reach,
and went no further. It avoided major arteries and other vital organs. By the
purest of chance, I should think. I pushed the sleeve of the biro through the
hole, and she breathed.

It sounded like nothing on earth, it looked more like death
than the convulsions and the blue skin, but oddly enough it was the sound of
life being grasped, firmly, by a hand that wanted it badly and would get it. It
became stable, still not anything like normal, but stable, and her eyes opened.
She seemed to see me.

Her friend, who had breathed little more than she had in the
last two minutes, fell half on top of me, and then completely on her, and cried.
A relaxed, uninhibited kind of crying. Her tone told me that her friend would
recover. I knew it because she was breathing. The friend knew it because she
could read the other’s mind, and understand those parts of the universe that
understood what was and what would be. The girl’s face at that moment was
beyond my understanding.

What I do know is that nothing I have ever felt in my life
is comparable to the moment when I knew she would live. It was simple relief.
The obligation to do something so momentous was over, and it been successful. I
could relax. No more than that. I didn’t know the girl. If I hadn’t passed by
just then I would have read of her death in the paper and not batted an eyelid.
But I was there. I did it. And it felt good.

She was conscious when the ambulance turned up, still
breathing strangely, but conscious and calm. She didn’t know what had happened
to her, and she felt some discomfort, but she could see her friend’s face which
told her she was ok, and she was with people who knew what they were doing, so
she would be fine. The ambulance crew cleaned her up, stuck tubes in her, and
took her away. They wanted to take me with them, to treat me for shock, but I said
no. I was ok. I was more than ok. I felt terrific. They even had the courtesy
to congratulate me on the competence of my butchery. I knew they were lying,
but what the hell.

Which lasted a couple of miles. I had to sit down by the
path, call a taxi to take me home, and consider the matter with the help of two
large Scotches (in Spain, large means biiiiig). It’s just life, I was managing
to persuade myself. The poor girl will have a nasty scar, which she will hate
me for, but she’s alive. It all worked out right, because by the purest chance I
had just learned the basics of the exact technique she needed. Sometimes life works
like that. It ended well. Be happy about it.

That afternoon I got a call from Santos, the doctor, my
student. Of course, that was the day he was giving his lecture. He would be
calling to tell me how it went. But no.

He never gave that lecture. He was in my little city, at the
hospital. He had been about to take the stage when the call arrived. His
12-year-old daughter had suffered some kind of attack while visiting a friend.
She had been given an emergency tracheotomy, which had saved her life. I wished
him the best, her a swift recovery, and finished the bottle of whisky.

Fiction! You bastard! Bloody great story though, and written in such a captivating way. Believing it to be true at first, makes it stunning. I only started to doubt you (a bit) in the final paragraph but I so wanted it to be true. In a way it is true because you played it out in your mind and inserted in the minds of the reader. It has believability though, which makes for the best fiction. And powerful, yes.

Thanks for the good review, Brett. Yes, in a way it is true, exactly in the way you say. There is no butchered girl, thankfully, but there is a doctor client who gave such a presentation which stuck in my mind so clearly that later I was sure I could perform the procedure if I had to. From there to imagining the situation around every corner is not much of a step.So much of it existed in my mind as 'a form of true event' before I thought it might make a good story, that it got written that way. Then I realised that to make it work I had to close the circle at the end, hence the last paragraph is in a slightly different style.